vomiting, but at times a feeling of nausea, and rising of bitter mucus in the throat. There was a very unpleasant odour from the mouth; the bowels were sluggish. On examining the abdomen, there was found, to the left of the epigastrium, a hardness, of the size of the hand, below the cartilages of the false ribs, not painful on pressure. About five weeks before his death, which took place on the 18th of March, 1847, ascites supervened, but not to any great extent. On examination after death the uterus was found somewhat increased in size, adherent superiorly to the sigmoid flexure of the colon, anteriorly to the posterior aspect of the bladder, posteriorly to the rectum, with which there was a communication formed, though it did not appear that this communication had been discovered during life; there were considerable traces of inflammation of the peritoneum adjacent to these parts. On slitting open the colon and rectum the mucous membrane was seen in a peculiar state of partial erosion, which gave it a somewhat reticulated appearance, and whilst the mucous membrane was thus engaged, the peritoneum did not seem to participate, inasmuch as this membrane could be elevated in many places, and the disease seen distinctly beneath it, the above-mentioned inflammation being apparently of a diffusive character, unconnected with the original disease. In the uterus the ulceration appeared to have commenced internally in the neighbourhood of the cervix, and to have gradually eaten its way posteriorly into the rectum; the usual appearance of the os tinca was gone, the lips being destroyed, and the upper part of the vagina contiguous implicated; the upper portion of the uterus had escaped ulceration, but when cut into the fundus was found hard, and resembled in appearance an unripe pear. The disease had tended to a fatal termination by anæmia and by peritoneal inflammation, the former being the immediate cause of death. Mr. Boult remarked that this case resembled much more the character of lupus, than that of true cancerous disease. On examination after death there was found a number of tubercles in the cellular membrane under the skin of the abdomen, some were as large as small horse-beans, but the majority were of the size of small split peas: they were found nowhere else. The cavity of the abdomen contained about two quarts of serum; the stomach was adherent to the under surface of the liver; a number of tubercles were under its peritoneal coat, and between the layers of the omentum majus and minor; the coats of the stomach were much increased in thickness, especially towards the cardiac extremity. On laying it open the mucous coat was found ulcerated in the neighbourhood of the cardia, but the pylorus was free; the cavity of the stomach was much diminished in extent, and presented on the whole a well-marked specimen of gelatiniform cancer. The intestines were natural, and the liver healthy; the kidneys pale and flabby; the spleen and pancreas were softened, the latter having a few carcinomatous tubercles on its upper border. The heart was found atrophied with patches of ossification in the coronary arteries; there were several patches of lymph under the pericardium, one especially at the apex, which presented a suspicious appearance; there were a few CASE XXXVI.-Ulceration of the larynx, and tubercular cretaceous tubercles at the apex of the right lung. disease of the lungs. Mr. Barrett exhibited the larynx and part of the œsophagus of a patient who had been under his care, chiefly complaining of difficulty of swallowing. The attempt gave rise to pain and vomiting. There was greater difficulty in swallowing fluids than solids. There was pain on pressure over the larynx. The individual sank gradually from exhaustion. On dissection there was found ulceration of the Mr. Field remarked on the following points in the case as presenting some interest:-1st. The tubercles under the skin of the abdomen; they might have been useful in diagnosis, combined with the hardness in the epigastrium, but unfortunately were not observed daring life.-2nd. The absence of pain and vomiting. Might the former in some degree be referred to the affection of the heart? A circulation so weak might probably modify sensibility. As there was no diffi-epiglottis, both on its lingual and laryngeal surface; culty in the exit of the contents of the stomach, and as its coats were so thickened and rigid, vomiting would not be likely to occur.-3rd. The co-existence of cancer) and tubercle. There could be no doubt that the cretaceous masses in the apex of the right lung werelated disease of the œsophagus; but the passing of a transformed tubercles. This co-existence has been observed before, though not of common occurrence. CASE XXXV.-Corroding ulcer of the uterus. Mr. Boult exhibited a specimen of corroding ulcera. tion of the uterus, which occurred in a woman 52 years of age. She had not been under Mr. Boult's care, but it appeared that she had enjoyed tolerably good health during the greater part of her life; she had menstruated regularly until within six months of her death, at which time the regular discharge was supplanted by a constant sanguineous drain, with occasional attacks of profuse hæmorrhage, which brought her into a very low condition. She suffered severe pain in the back, and occasionally in the hypogastrium. also of the antero.epiglottidean ligament, and on the posterior internal surface of the larynx. There were tubercular cavities in the lungs. Mr. Barrett remarked on this case as having simu bougie removed the doubt. The symptoms of phthisis were not clearly marked. Foreign Department. "ABSTRACT OF THE PROCEEDINGS OF THE ACADEMIE DE MEDECINE. The séances of this Academy during the past month have exhibited but a moderate amount of interest. DISLOCATION OF THE PELVIS. M. Begin read a report on a memoir by M. Murville on luxations of the pelvic bones, of which the author narrates two remarkable examples. The first was the ACADEMIE DES SCIENCES, PARIS. case of an officer who fell from a second-floor window, 635 subsequently to lithotomy, and 10 recent cases, making NEW OPERATION FOR STONE. M. Maisonneuve presented a patient from whom he the rectal operation. The description is as follows :— The surgeon then introduces the index finger of the left hand into the rectum, and feeling for the staff, inserts the nail into the groove. This being done, a sharp-pointed bistoury, perfectly guarded, is slipped along the finger as a director, until its point inpinges upon the groove of the staff; it is then made what by stimulants, and when re-action was fully established, he was treated antiphlogistically, the dis-had removed a stone by a new method, which he calls placed bones being maintained as motionless as possible. No attempt at reduction was considered advisable. This treatment was marvellously successful; not only did the patient survive, but the paralysis diminished, and in ten days the patient was able to walk with difficulty. The second case is unique. An officer during a review was run away with, the horse at the same time plunging violently; in one of the plunges he was thrown considerably from his saddle, upon which he descended again with such force as to lacerate the left · side of the pelvic arch, without injuring the skin. A second plunge of the animal added to the mischief, completely rupturing the ligaments of the symphysis 'pubis. When examined, a large inguinal hernia was 'discovered on the left side, and in the perineum a tumour projected as large as the fist, which could be pushed upwards into the pelvis. The symphysis pubis was separated to an extent which allowed the hand to be insinuated between the ossa pubis. The hernia was reduced, and the bones kept in apposition by bandages, and in three months the patient was able to walk. M. Murville upon this case founded some remarks upon the feasibility of the operation of division of the symphysis in labor. In a discussion which ensued, M. Malgaigne doubted that it was a case of simple dislocation, thinking it probable that there was also fracture. STATISTICS OF LITHOTRITY AND LITHOTOMY. After the presentation of memoirs on pellagra and vaccination, which are not of interest to the British reader, the discussion on lithotomy and lithotrity was resumed. M. Civiale, who opened the debate, gave a statistical account of stone operations in different localities. In Bristol, of 135 operations between the ages of one and ten years, 28 or one in 4.68 died. Of cases by Dr. Yelloly, on subjects under fourteen, 69 died out of 357 cases, or one in 5. 17. Of 100 operations performed at the Hotel Dieu, 56 were cured and 28 died. Between the years 1836 and 1842, 73 operations for stone have been performed in the hospitals of Paris, on patients of all ages; of these, 45 were cured and 25 died; in 3 the issue was unknown. This makes a mortality of one in 3. In 89 operations by Dupuytren, on patients under the age of fourteen, the recoveries were 70, the deaths 19,-that is to say, 1 in 4.66. Such are In opposition to the results of the operation for stone. this, M. Civiale adduced the following statistics:Of 838 cases of stone which presented themselves to him between the years 1824 and 1845, 548 were healed by lithotrity; the remainder were not considered proper cases. To these 548 cases he adds, 25 cases of lithotrity from relapses, 8 in which lithotrity was performed to divide the walls of the rectum and the urethra. M. Jobert exhibited a boy whose lower jaw he had removed for disease of the bone, consisting of hyperThe operation does not trophy, with eburnation, and containing large cavities, offer any points of more than ordinary surgical interest. filled with caseous matter. ABSTRACT OF THE PROCEEDINGS OF THE The principal communications to be noticed are the following: TREATMENT OF FEVER. " M. Serres read a lecture on the "Remedial Treatment of Fever." He commenced by assuming that 1. The exanthem as the typhoid fever like other exanthematic fevers, consists of two distinct elements. basis. 2. The group of phenomena, the assemblage of which is known as fever. These, he considered, to bear a definite relation to each other, the severity of the latter being proportionate to the extent of the former. The origin of his predilection for the mercurial treatment of typhoid is to be traced to this supposed analogy. Finding that the varioloid eruption may be aborted by mercurials, as the Emplast. Vigo cum Mercurio, &c., it occurred to him that a similar mode of treatment might be beneficial in fever. His method is the following:- Internally he gives the black sulphuret of mercury, in four-grain doses, three or four times a day; externally he uses the mercurial ointment by friction on the abdomen. This treatment he continues six or eight days, unless ptyalism occurs, when the dose is diminished. According to M. Serres, the headache and fever are speedily diminished by this treatment; adynamic symptoms are prevented. The quantity of the sulphuret required is seldom more than a drachm. Convalescence is established by the eighth to the fourteenth day. PURULENT OPHTHALMIA IN INFANTS. M. Chassaignac addressed a letter to the Academy in which he details some new facts relative to the purulent ophthalmia of new-born children. He has ascertained that if the purulent matter be carefully washed away, a false membrane may generally be detected. This membrane is greyish, and very adherent; it is mostly found on the palpebral reflection of the conjunctiva; its presence he believes to be the great obstacle to the cure of these cases, and he states that after its removal the case generally proceeds satisfactorily, either because it acted as a foreign body, or that it prevented the contact of the collyria with the diseased tissues. The author likewise pointed out the striking benefit he had witnessed from repeated forcible syringing or douching of the eye with cold water. He states that since he has adopted the practice he has not lost a single eye, in fact that the cures are now as frequent as before they were rare. The resumé of his observations is thus given:—1. Purulent ophthalmia of new-born children is a diphtheritic inflammation, tending to the production of false membranes. 2. This membrane is so adherent that it can only be removed by peeling it off with forceps. 3. Irrigation of the eye and eyelids rapidly induces a cure. M. Tavignot communicated his experience on the advantage of submitting patients to gentle salivation previous to operating upon them for cataract. By these means, iritis and keratitis, the two great drawbacks to the success of the operation, are stated to be frequently prevented. subject as are in their possession. The speech as here reported is authentic. Mr. Daniell after reading the resolution entrusted to him, addressed the meeting as follows: Mr. Chairman and Gentlemen,-One of the peculiar privileges of Englishmen, and one of the blessings which belong to a free and enlightened Government, is the facility which it affords its people of representing their wrongs and of granting them redress. To assume a character of indifference, to be careless to the legiti mate claims of any section of the community when those claims are fully and fairly established, or to turn a deaf ear to undeniable truths, would argue a measure of moral turpitude and guilty negligence which I should be sorry to attach to any state! (Hear, hear.) Indeed I cannot believe in these enlightened times that any Government will wilfully do wrong. The difficul ties which beset legislation are obvious enough, and there may be cases where, to accomplish general good, great partial evil may prevail. The income-tax is an example of this kind of evil. I attach no improper motives to the parties who introduced that measure, but I, in common with my professional brethren, writhe under its exactions. (Hear.) The object, however, of this convention of union medical officers, is to solicit the aid of Parliament, not to abrogate a law, but spare us an infliction for which no law exists. Our aim is to solicit Government to step between us and an arbitrary and grinding system, where the will of men, and not the laws of our country, is the paramount authority. We are met to claim from the Legislature their kindly assistance, so to organize the principles of medical relief to the sick-poor, that the latter may reap the benefit of good advice, and that the advisers themselves may be remunerated to an extent becoming their characters as gentlemen, and worthy their consideration as skilful and intelligent men. (Cheers.) I am no enemy to a proper system of economy. I laud every institution that has an eye to the careful expenditure of its funds but there is a wide difference between a M. Marchal de Calvi presented some analyses of the griping parsimony and a proper economy-the former blood of scorbutic patients. invariably inflicts evil upon itself, while it fails not to M. Sedillot read a paper on ætherization which is render wretched the victims of its baseness. (Cheers.) without interest. THE MEETING OF UNION MEDICAL OFFICERS. We all know that, under the new Poor-law Bill, a board of guardians has been appointed in every union to transact the business appertaining to that union. We also know that that board is composed of a heterogeneous compound of character, of men as versatile in their powers and capacities as it is possible for versatility to go, and that perfect union of opinion amongst them would be a circumstance scarcely to be anticipated, both anomalous and extraordinary! You will remember, too, that it is not the weight of intelligence which carries the day in these assemblies. No, it is the majority of votes. I wish not to In consequence of the lateness of the period at which we received the more circumstantial account of the proceedings of the London meeting of the medical officers of Unions, we were unable to report Mr. Daniell's speech in full. As this eloquent address seems to embody the leading features of Poor-law grievances, we have been requested by some influential members of the Provincial Medical and Surgical Asso-reflect upon these gentlemen-doubtless they are worthy ciation to give it insertion in the present number of the Journal, partly that the views of Mr. Daniell may be more generally made known to the Association, and partly that other gentlemen engaged in union practice may be induced to furnish the Committee appointed at the meeting with such data and facts bearing on the and excellent personages according to their vocation, but I will say that intellect is not so rife amongst them as to shine on all occasions with extraordinary brilliancy. If, then, there be a lack of this peculiar commodity-if the majority of that board be composed of men of very ordinary capacities, of limited MEETING OF POOR-LAW MEDICAL OFFICERS: intelligence, of narrow views, and narrow conceptions of the dignity of mind-how shall they grapple in their dealing with men who offer mind as the article of barter? Do men in general put a high value upon Are they not that which they do not understand? disposed rather to underrate-nay, to consider as nothing that which is not tangible like a bale of goods, a sample of corn, or a fat beast? (Cheers.) When, these therefore, the medical officer is to be engaged, gentlemen have an immediate eye to a rigid system of parsimony, and without a due reference to the quality of the material-for of the quality they know nothing their object is to get what they need at the cheapest rate. (Hear, hear.) Are medical men in the conventional usages of society different from others? Will they willingly abandon their own interests, and, with a Quixotic spirit, encounter dangers and difficulties for the mere love of it? (Hear, hear.) Will they visit the houses of the poor, dispense the peculiar blessings of their order, hang over the sick bed of contagion, and breathe the poison of pestilence-will they watch the suffering victim, and smooth his dying pillow-will they be ready at a moment's warning to leave their cheerful hearths, or in the bitterness of an inclement season quit their beds, to ride over plain and upland, by fearful precipices or gloomy ravines, entering the squalid habitations of destitution and misery amidst foulness and filth-to allay the anguish of disease, or to check the progress of some awful and destroying malady? To the honour of my profession be it said, they will!! But is it consistent with the principles of humanity is it in accordance with the duty which man owes to man, that such services should be unrewarded, or that they should be paid for at a rate which makes it little better than charity on our parts, and which puts profit out of the question? I must reiterate what I have said elsewhere. That there are venal men in our profession-who will doubt?-for there are venal men in every profession. Such men contract with a board of guardians for attendance on the poor, but they contract with a mental reservation that they will not be losers. Who then is the victim? Why, the poor sufferer who is deprived of what might benefit him, because valuable remedies are withheld. In a secondary sense, the board of guardians too, for the protracted illness of the poor patient, protracts also his weekly payments, and swells out the relieving officers' accounts far beyond what would have been an equivalent for the better duties of a medical officer. Oh! that men would see the cogency of truths like these, for they are damning evidences of a bad system. (Cheers.) But it might be argued-give us evidence that you are ill paid, prove that boards of guardians are parsimonious, or that the Commissioners are wanting in attention to your claims. I make no doubt that many gentlemen here present are prepared with facts to illustrate my assertion, viz., that in the majority of the unions of this kingdom the salaries of the medical officers will not pay for the value of medicine, if dispensed and charged by an ordinary druggist. But I will illustrate my position by taking the Newport union as an example. I have here a list 637 of parishes, the amount of population, and the yearly. NEWPORT PAGNELL UNION, 1847. £2 0 0 4 0 0 210 0 0 10 3 0 0 5 10 1 10 16 0 0 .... 0... Bradwell Clifton Reynes North Crawley Emberton Gayhurst Haversham Lathbury Population. 212 410+ 374 0 .... 213 865 658 0 116 0 1553 83 .... 283 £216 0 0 You must bear in mind, gentlemen, that many of these parishes are heavily burdened with poor; that in many instances they are five and six miles from the residence of the medical officer; that there are many toll-gates; and that in consequence of the high price of provision last year distress and destitution prevailed in no ordinary degree, and as a consequence disease prevailed also. You may be disposed to ask how gentlemen, valuing their attainments, putting the slightest estimate of worth upon their powers, and anxious to support the dignity of their calling, could possibly accept of appointments which, in the first place could not be remunerative, and in the second was degrading to their dignity and character. The truth city "He gied the hospital a ken, 'Twas all he gied; but then,' quoth he, 'I'll something gie, my lord, d'ye zee, When I come here agen.*"* (Cheers.) But enough of complaints. How are these evils to be remedied! Oue thing is obvious; we must is, that from year to year we have been led to expect | last century says, when royalty passed through a certain a change; we have been induced to think that so crying an evil must meet with its remedy from the hands of those whose especial business it was to correct abuses. In the very early stages of our career, almost at the beginning of the new law in our neighbourhood, we, the medical officers of the union, presented a remonstrance to the board, setting forth our claim for more ample remuneration. But this remonstrance failed in producing any very beneficial effect. We next memorialized the Poor-law Commissioners, and they were courteous and attentive, for they furnished us with a very polite and very laconic reply, stating they had sent our memorial to the board! Then doubtless it experienced the fate which certain bills do in another house, ordered to be read that day twelve-months! (Laughter and cheers.) Yes, there can be no doubt that that poor memorial served to comfort and warm the gentlemen so graphically described by Dickens, as wearing white waistcoats, or some veritable Bumble, while it blazed and crackled on the board-room fire. (Cheers.) Still we did not despair. "A dinner of the best; Lo! to a turn the different joints were drest." I do not think any of us grew pot-valiant on that occasion, but we came to a conclusion that we would go in a body to the board of guardians, and try the effect of a viva voce representation. By a strange obliquity of judgment I was made the mouthpiece of the party, and to the best of my abilities I endeavoured to show the wrong which each of us had sustained. As far as I was individually concerned, I proved beyond the possibility of contradiction, that I had during the last twelve months dispensed medicines to the poor, and charging for it at a rate which a druggist would charge allowing nothing for journeys, for time, for skill-I was absolutely minus £24. (Hear, hear.) Did this representation produce any effect? Truly it did, for the commissioner who was present overwhelmed us with high eulogistic compliments upon our gentlemanly behaviour, for our temporate exposition of facts, which he declared, in all his experience of similar complaints, had no parallel! He intimated, moreover, that he should invite some of us to dinner when he next came to Newport Pagnell, that we might quietly talk over the business, with a view to a satisfactory arrangement. Alas, for our organs of gustativeness! The salmon has never leaped into the net, or the mutton fattened in the pastures, which has to grace our table on that auspicious day. (Laughter and cheers.) The dinner and the consultation found a grave in forgetfulness, and we are still as we were. So true it is that the best motives and principles are frustrated in their effects by the baleful influence of procrastination. As a keen satirist of the remedy them ourselves. We have now assumed our proper position. We come not like factious men to violate laws, or break the bonds by which society is united. We have combined for a legitimate purpose; and it is our intention to carry our grievances where they ought to be redressed-to the fountain of law itself. And what is it we ask? Simply that which is conceded to the lowest subject in the realm-a fair remuneration for our labours, an adequate compensation for arduous and painful duties imposed upon us, And surely we have a high justification, for is not "the labourer worthy of his hire?" (Hear, hear.) Let us, then represent to the Government, that medical remuneration for attendance on the sick poor legiti mately belongs to them; that they are in a position to take upon themselves the responsibility, because they take upon themselves to pay half the expenses. (Hear, hear.) Let us urge upon them the necessity of a fixed and settled principle, either to tax the parishes according to the amount of population, or to employ some distinguished actuary to form a correct scale of charges according to the returns of sickness and mortality, bearing in mind extra-charges for mileage according to the distance which the medical officer has to travel. This, in my opinion, is a most essential consideration, and it will produce one good effect, for it will necessarily limit the districts within suitable and proper dimensions, and put an end to that preposterous practice of engaging medical officers whose residences are so remote that their services are scarcely available. (Cheers.) One or two more observations and I have done. Contrast for a moment the conduct practised towards us as medical men, with that adopted towards the clergy. No man entertains a higher reverence for the church than I do. No man estimates the value of the clergy more than I do. God forbid that I should utter a syllable that would tend to militate against their holy and exemplary office; but I must be pardoned if I question whether the duties of a clergyman are superior or even equal to ours. Nay, I con. tend that the labours of the one and the other cannot be put in juxta-position. Yet would you believe it, I read in a public journal the other day, in the items of the expenses of a county gaol, that the surgeon's salary was £80 a year, while that of the clergyman was £200. Surely, thought I, there can be no comparison betwen the services of the one and the other. (Hear, hear.) The clergyman preaches his sermon on a Sunday, may have prayers in the week-day, and occasionally visit the sick; but the medical man furnishes medicine, gives daily attendance, and in severe cases is ever at the call of the authorities, and is liable to be disturbed in the midle of the night to encounter pestilence in all its forms and characters, and perform professional duties difficult and dangerous to himself. |